211 -Relapse Prevention Strategies for Coaches and Counselors

Relapse Prevention Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director AllCEUs Objectives ~ Define relapse in terms of addiction as well as mental health ~ Examine relapse prevention techniques ~ Explore needs of the person: Psychosocial and Maslovian What is Relapse ~ Relapse is the return to addictive behaviors or the recurrence of mood symptoms ~ Relapse often starts long before the person uses again ~ Get caught up in day-in-day-out ~ Start acting “mindlessly” ~ Stop going to meetings/counseling/church/lifeline ~ Begins running out of energy to do new behaviors ~ Frustration, irritability and exhaustion set in ~ Caveat…an extreme stressor can prompt “immediate relapse” Relapse Definition ~ Relapse is the return to something that has been previously stopped ~ Relapse is multidimensional ~ Emotional ~ Mental ~ Physical ~ Social ~ A relapse is when you start returning to any of these people, places, things, behaviors or feeling states. Extreme Stressors ~ Those things that overwhelm an individuals ability to cope ~ Thrust them into the fight or flight ~ New coping skills and support resources may not even be considered, or only half-heartedly ~ Have clients identify or practice dealing with these types of situations in group ~ Divorce ~ Death ~ Job Loss ~ Diagnosis of a terminal or chronic illness (Cancer, ALS, HIV) Beginner Tools for Extreme Stress ~ Get support… You are outnumbered! ~ Self-soothing/De-Escalation ~ Systematic Desensitization ~ Cognitive Behavioral Therapy ~ CPT Note Card ~ I feel… because …… ~ What am I upset about ~ What are the FACTS for and against this belief ~ Am I using all or nothing thinking or jumping to conclusions ~ I need to call _______ to get an objective perspective or what would _____ do

The 4 Ds ~ Delay – Most urges, feelings and cravings rise and fall like waves in about 20 minutes if you do not “feed” them ~ Distract – Craving time passes more quickly when engaged in a distracting activity for a few minutes. ~ Use Distress Tolerance Skills to IMPROVE the moment and ACCEPT reality. DBT Video ~ De-Stress – By reducing your stress and distress, you are allowing your body to maintain higher levels of calming and “happy” chemicals. ~ For more tips, listen to the Happiness Isn’t Brain Surgery Podcast on preventing vulnerabilities. ~ De-Catasrophize – Challenge your thoughts and when necessary, reframe them into more accurate notions, like, “This is really uncomfortable, but I can manage.“ ~ Video on thinking errors Relapse Prevention Card ~ Fold a paper into four squares: ~ On the first square, write: “Delay, Distract, De-Stress, De-Catastrophize ~ On the second square, write out 5 personally relevant distraction ideas ~ On the third square, write out 3 of your most significant reasons for wanting to recover ~ On the fourth square, write out some negative expectations – accurate predictions for what will happen if you slip (over eat, smoke, drink, say “yes” when you need to say “no”) Creating a Relapse Prevention Plan ~ Triggers and Vulnerabilities are multidimensional ~ Emotional ~ Mental ~ Physical ~ Social ~ Environmental ~ Cravings: Compile a list of who you can call, what you can do to distract yourself from a craving and how you could stop a craving altogether. (gambling, smoking, sex, over eating) ~ Healthy tools: Think about what new and old behaviors/tools you can use to keep you on the right track. Some examples include writing a list of consequences should you relapse, attending a support meeting, exercising, journaling, or writing a gratitude list. Emotional Relapse ~ In emotional relapse, your emotions and behaviors become negative and unpleasant. ~ You start finding it difficult to experience pleasure ~ What triggers your negative emotions (Anger/resentment/jealousy/guilt; depression; anxiety/fear/stress) ~ Things/Media ~ People ~ Places ~ Events Emotional Relapse ~ Negative emotions make us uncomfortable ~ Identify the emotion, explore why you are feeling that way and take steps to fix the problem ~ You can become stuck in the emotion, sometimes ~ Nurturing and blowing it out of proportion ~ Compounding it with other emotions like anger and guilt ~ Personalizing it ~ Trying to escape from it ~ Remember that emotions are just cues like a stoplight. ~ You feel how you feel in the moment ~ You can choose to change or improve the next moment Preventing Emotional Relapse ~ Practice mindfulness ~ Increase positive experiences (real and guided imagery) ~ Keep a gratitude journal ~ Avoid personalizing something that may not be about you ~ Remember that… ~ Negative emotions are the mind’s way of telling us to get off our butts and do something—Like our car’s idiot light or hunger pangs ~ Dwelling on, nurturing, avoiding or hiding from negative emotions never makes anything better ~ You can *choose* to feel and fix, or relapse and repeat

Activity ~ List 10 things that you chose to get anxious or angry about over the last week ~ Why did you get upset? (What was your mind telling you needed to be fixed) ~ Did holding on to the upsetness do any good? ~ What was your initial reaction, and was it helpful? ~ What could you do differently next time to either ~ Change/fix the situation (Improve the next moment) ~ Change how you feel about the situation (Walk the middle path) ~ Let it go (Radical Acceptance) Mental Relapse ~ In mental relapse there's a war going on in your mind. ~ Part of you wants to stay positive, but part of you is struggling with tolerating the distress. ~ The signs of mental relapse are: ~ Focusing on the negative ~ Having a pessimistic/helpless/hopeless attitude ~ If you had an addiction (food, nicotine, drugs, relationship), you may also be: ~ Thinking about people, places, and things you used with ~ Glamorizing your past use ~ Lying to yourself and others ~ Justifying your behaviors ~ Minimizing the impact of one (drink/hit/bet etc.) ~ “Screw It” attitude

Connecting Unpleasant Thoughts & Feelings Preventing Mental Relapse ~ KISS: Keep It Simple Stupid ~ Trying to change too many things at once can lead to failure ~ Often some of simplest things can have the greatest impact ~ Prevent and address vulnerabilities that can make you focus on negative or have a strong, negative emotional reaction ~ Good Orderly Direction ~ Your life is a road map ~ The destination is recovery and happiness ~ Before you act, think whether that keeps you on the right road, or is an unplanned detour ~ Maintain Head-Heart-Gut Honesty (Rational, Emotional, Wise Mind)

Social Relapse ~ Symptoms ~ You have returned to the old people and places who co-sign on your b.s. ~ You have withdrawn from your social supports ~ You have become self-centered ~ You have withdrawn ~ What triggers your social relapse ~ People ~ Places ~ Things ~ Events Preventing Social Relapse ~ Contact your social support(s) on a daily basis for the first 3 months ~ Keep a business card in your wallet with the names and numbers of 3 social supports ~ Change your phone number (if possible) and destroy contact information for people who might trigger a relapse ~ Find at least one prosocial activity to do each week —volunteer, church, go to the gym Physical Relapse ~ Physical relapse is characterized by: ~ Fatigue ~ Increased anxiety ~ Difficulty sleeping ~ Neglecting physical health (sleep, exercise, nutrition, medication) ~ If there was also addiction… ~ Cravings ~ Dreams about the drug

Preventing Physical Relapse ~ HALT ~ Hungry ~ Nourish your body with proper nutrition ~ Nourish your mind with activities and things that increase “happy chemicals” ~ Angry/Anxious ~ Reduce chronic stress ~ Lonely ~ Nurture social supports to buffer stress ~ Be willing to ask for help ~ Tired ~ Get sufficient quality sleep ~ Address issues such as sickness and pain that prevent quality sleep Relapse Prevention Planning ~ Review Strengths ~ What is life like when you are happy? ~ What is different? ~ What is the same? ~ List three ways you cope with stress. ~ What activities do you like to do? ~ What are your positive qualities and strengths? ~ How can you use this information to prevent relapse. Relapse Prevention Planning ~ Review Prior Relapses (and recoveries) ~ What was happening before the relapse/recovery? ~ What triggered the relapse? ~ Change occurs when old behaviors are more rewarding or stronger than new ones. ~ Relapse: What became more rewarding than your recovery program? ~ Recovery: What made doing the hard work of recovery so rewarding?

Relapse Prevention Planning ~ Review Prior Relapses (and recoveries) ~ Before you relapse, what changes in ~ Your emotions ~ Your thoughts ~ Your behaviors ~ Your interactions with others? ~ As you recover, what changes in ~ Your emotions ~ Your thoughts ~ Your behaviors ~ Your interactions with others? ~ What have you learned? Creating a Relapse Prevention Plan ~ Relapse Warning Signs ~ Warning Sign: Feeling unable to cope ~ General Coping Strategy: I will learn how to say no to taking on extra projects, limit my work to 45 hours per week, and learn how to use relaxation exercises and meditation to unwind. ~ Warning sign: Irrational thoughts ~ Irrational Thought: I need to try harder in order to get things under control or else I will be a failure. ~ Rational Thought: I am burned out because I am trying to hard. I need to time to rest or I will start making more mistakes. Relapse Warning Signs ~ Warning Sign: Unmanageable Feelings (Humiliation, embarrassment, Failure) ~ Feeling Management Strategy: Talk about my feelings with others. Remind myself that there is no reason to embarrassed. I am a fallible human being. ~ Warning Sign: Self-defeating Behavior: Driving myself to keep working even thought I know I need to rest. ~ Constructive Behavior: Take a break and relax. Ask someone to review the project and see if they can help me to solve the problem. Relapse Prevention Planning ~ Creating the Plan ~ Why do you want to change? ~ What are the most common pitfalls for your relapse? ~ What you can do to prevent that from happening again? ~ What has worked in the past? ~ Create a schedule including ~ Recovery activities ~ Work ~ Reflection time ~ Positive health behaviors including nutrition, exercise, sleep ~ Nurturing positive relationships Self-Esteem ~ A sense of pride in who they are ~ Acceptance of strengths and weaknesses ~ Lack of self-esteem can lead to a need for external validation ~ Self-Esteem workbooks abound to develop positive self esteem ~ Eradicating harsh, self-critical self-talk is the second part (Taming the Critical Inner Voice) ~ Be aware of the imposter phenomenon.

Mindfulness ~ Relapse often begins when mindfulness ends ~ Mindfulness is being aware of ~ Who you are ~ How you feel (emotionally, mentally, physically) ~ What you want (and what you actually need) ~ Are you eating because you are hungry or stressed ~ Are you sleeping because it is time or because you haven’t been sleeping well? ~ What not getting wants met mean to you ~ Activities ~ Morning and evening journals ~ Behavior Interruption esp. regarding substitute addictions

Mindfulness ACT Matrix

Summary ~ Relapse prevention begins with remaining aware of your wants, and needs ~ Relapse begins when the old behaviors start to surface ~ Avoidance ~ Minimization ~ Rationalization ~ Denial ~ Numbing ~ Anger/resentment/regret ~ People need to learn how to self-govern as a part of recovery

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